Application For Employment

Step 1: General Information

Position Applying for:

Date:

Community Applying for:

Salary Desired:

Date Available:

It is the policy of Eskaton to provide employment, training, compensation, promotion and other conditions of
employment without discrimination on the basis of race, religion, color, national origin, ancestry, marital status,
military status, gender, physical or mental disability, sexual orientation or age.

General Information

Last Name

First Name

Middle Initial

Address

City

State

Zip

Home Phone

Cell, Work or Message Phone

E-mail Address

How did you here about Eskaton?

Walk-In

TV/Radio

Newspaper

Eskaton Referral

Eskaton Website

Online Job Board

Other

Check Work Availability

Days

PM's

Nights

Full Time

Part Time

On-Call

Temporary

Weekends

Holidays

Other

Are there any specific days or times you can not work?

Yes

No

If Yes, Please list days/times you can not work:

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

If no, describe the functions that cannot be performed:

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination and to skill and agility tests)

Personal Information

1. Have you ever filed an application with Eskaton before? If yes, when?

Yes

No

2. Are you under 18 years of age? (If yes, a work permit will be required)